How a Changing Regulatory Climate is Paving New Roads for At-Home Virtual Care

By Peter Antall, MD, Chief Medical Officer, American Well; a HIMSS Interoperability Showcase Collaborator

In 2019, The Centers for Medicare and Medicaid Services (CMS) finalized new policies to extend telehealth coverage for Medicare. In addition to creating brief virtual check-ins, CMS has eliminated geographic restrictions for opioid addiction treatment, telestroke and dialysis monthly check-ins.

CMS also created additional current procedural terminology codes for remote patient monitoring and provider-to-provider consults. Beginning in 2020, Medicare Advantage plans can offer unrestricted telehealth services as a basic benefit for members. And, looking forward, a bill has been introduced in Congress that would eliminate the rural and site restrictions for telemental healthcare in the home.

These reforms in reimbursement policies are opening new doors for digital health among vulnerable older populations who are increasingly tech-savvy. According to Pew Research, in 2000, only 14% of those ages 65 and older were internet users; now in 2019, 73% are internet users. Today, more than half (53%) of seniors own and use a smartphone. Uncoincidentally, more than half (52%) of seniors also say they are willing to see a doctor via video. This means that of the 47.8 million Americans over the age of 65, 24.85 million are willing and ready to use telehealth today.

Thanks to a chipping away of the reimbursement restrictions from Medicare and an increase in technology adoption among the elder population, many leading healthcare organizations are developing digital strategies to help provide ongoing care for this vulnerable population.

Virtually Treating Hypertension and Accompanying Comorbidities

According to the Blue Cross Blue Shield Health Index, hypertension is the top health condition impacting Americans today. While hypertension affects all age groups, it is most common among older populations. In the United States, 76% of those between the ages of 65 and 74 and 82% of those over 75 years old have hypertension. Hypertension is a major cause of morbidity and mortality in these populations as it often leads to serious complications such as congestive heart failure, stroke, heart attack, or kidney disease.

Digital strategies can be used to help monitor and care for patients with hypertension. Netsmart integrated virtual care that offers the potential to improve health outcomes and lower costs by improving access and allowing frequent touchpoints. Through the program, individuals who present at a hospital with hypertension and are then referred to a home health provider can be monitored and treated using a combination of in-person and virtual visits. The virtual visits utilize integrated technology enabling both providers and patients to access virtual care through familiar devices.

On the provider side, the visit can be conducted from within the EHR. On the patient side, individuals can initiate or join a visit through an existing mobile application on a consumer device like a smartphone or tablet. Providers use these virtual visits to monitor and check in on hypertension patients, can initiate further evaluations, and can prescribe and adjust medications as necessary.

“It’s about enabling patients and providers to take a more proactive and collaborative approach to care and wellness,” said AJ Peterson, vice president at Netsmart. “Leveraging virtual, in-home solutions such as remote patient monitoring and telehealth allows providers to deliver the right care, at the right place, at the right time, for the right person.”

Better Care for Those with End-Stage Renal Disease

While those who suffer from end-stage renal disease (ESRD) only account for 1% of the Medicare population, they account for 7% of the Medicare spend. That’s because most ESRD patients need to undergo three to five hours of dialysis treatment three or more times a week, and often require additional treatment for other chronic conditions that often accompany ESRD.

As part of CMS’s new telehealth reimbursement policy, geographic restrictions have been lifted for virtual dialysis patients’ follow-up appointments. Now ESRD patients can receive care in the home, changing the way healthcare organizations approach dialysis care. For example, Intermountain Healthcare recently announced a new Kidney Care Center that will provide at-home dialysis visits through telehealth to treat ESRD patients virtually.

Identifying Other Opportunities for Virtual Care

In addition to hypertension and ESRD, the senior population is interested in receiving other services via telehealth. Of those over the age of 65 who are willing to use telehealth, 84% said they would use it for prescription refills, 67% for chronic care management, and 60% for surgery or in-patient follow-up care.

Health systems like UMass Memorial and UAB Medicine have telestroke programs in place to provide immediate care for stroke patients in rural areas. There are also opportunities for provider-to-provider telehealth among the Medicare population. Provider-to-provider consults are also being used for psychiatry, cardiology and other specialties.

In 2020, the tides will continue to change for telehealth as CMS begins to reimburse for more telehealth services and Medicare Advantage plans start to include virtual care as a core benefit. These positive changes will also continue to empower provider organizations to rethink care delivery for services and specialties to help drive down costs and improve the care experience for an increasingly aging population.

To learn more about integrating virtual care into ongoing patient care, visit American Well and Netsmart at the HIMSS Interoperability Showcase.

Sponsored content. The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

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